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Sexual Function After Pelvic Surgery in Women
Author(s) -
Poad D.,
Arnold E. P.
Publication year - 1994
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1994.tb01274.x
Subject(s) - sexual function , libido , medicine , decreased libido , sexual dysfunction , sex organ , retrospective cohort study , surgery , general surgery , gynecology , psychiatry , biology , genetics
EDITORIAL COMMENT: We accepted this paper for publication since it will remind readers to discuss the possibility of postoperative sexual dysfunction. It should go without saying that sexual function before surgery should also be discussed, particularly since it may determine the type of surgery selected for genital prolapse with or without associated urinary incontinence. Our reviewer stressed the point that in spite of the oft‐quoted opinion of Francis and Jeffcoate (reference 4 in this paper), posterior colporrhaphy will not cause dyspareunia if excessive narrowing of the vagina is avoided. Narrowing in the mid‐vagina is caused either by excessive excision of vaginal epithelium or by excessive approximation of paravaginal connective tissue. Moreover failure to perform posterior colporrhaphy after anterior colporrhaphy, with or without vaginal hysterectomy, can accentuate weakness of the vaginal vault and posterior vaginal wall and result in rapid development of an enterocele or even eversion of the vagina. A final comment is that it should be routine to review women 6 months or so following pelvic floor surgery to review the anatomical and physiological results. The 4–6 week postoperative visit is too soon since many have not recommenced coitus at this time. Furthermore, problems with discharge or postcoital bleeding from vault granulomas are best excluded some time after resumption of coital activity. Summary: To assess the prevalence of sexual dysfunction after pelvic floor surgery for nonmalignant conditions, a retrospective survey was performed. Replies from a postal survey were received from 66 of the 200 women canvassed. Dyspareunia developed in 10 patients who had never had it before the operation, however of those who had it preoperatively the pain stopped completely in 12 of 23. Reduced libido was noted in 16 of 54 (29%), reduced lubrication in 21 (38%), and reduced genital sensation in 10 (18%). Lack of information about the potential effects of surgery on sexual function was identified as a major deficit and of considerable concern to 35 of the 66 women. Sexual function after surgery should be evaluated more intensively, and the subject discussed openly before any contemplated operation.